Page 943 - Small Animal Clinical Nutrition 5th Edition

Feline Lower Urinary Tract Diseases 975

Assess the Food and Feeding Method
Before the diagnostic evaluation the cat was fed primarily dry commercial food that was available at all times with occasional canned
VetBooks.ir food as a treat. Water was available free choice.

Questions
1. What disorders are associated with inappropriate urination and why is it important to identify the underlying cause?
2. How is FIC diagnosed?
3. What is the most effective approach for controlling clinical signs in patients with FIC?
Answers and Discussion
1. Inappropriate urination (i.e., periuria) may occur as a result of behavioral and/or medical disorders. Any medical condition that
causes inflammation of the lower urinary tract (e.g., FIC, urolithiasis, urinary tract infection) may cause urination outside the lit-
ter box. Behavioral periuria typically results from toileting problems or urine marking (spraying). Cats with toileting problems
have elected to use an alternate location other than the litter box because they have an aversion to or preference for a particular
substrate (e.g., litter) or litter box characteristics such as location, style and cleanliness. Cats with lower urinary tract diseases may
develop secondary toileting problems that may persist after correction of the underlying medical disorder and this must be distin-
guished from primary behavioral periuria. Urine marking is a means of communication and often is characterized by expelling
urine on vertical surfaces although cats may mark by depositing urine on horizontal surfaces from a squatting position. Finally,
aging cats with osteoarthritis may urinate inappropriately in the absence of primary behavioral disorders or urinary tract diseases
due to difficulty accessing the litter box (e.g., the sides are too high or the cat must travel up or down stairs to reach the litter box).
Inappropriate elimination is the most common behavioral problem for which pet owners seek professional counsel. It also is a
common reason why owners relinquish their cats to shelters. To prevent the negative impact of inappropriate urination on the
pet-family bond, it is important to educate pet owners about potential causes of inappropriate urination so they seek help before
relinquishing their cat. When medical causes are excluded, a veterinary behaviorist should be consulted so that appropriate eval-
uation and treatment can be recommended. This should be done sooner rather than later in the course of the disease, when the
chances are greater for having a successful outcome with behavioral modification.
2. The presence of pollakiuria and hematuria indicates that inappropriate urination in this patient is probably due to a medical dis-
order of the lower urinary tract. In a young to middle-aged female cat, the most likely causes for these signs are FIC and stru-
vite urolithiasis; less likely causes include uroliths of other mineral type (e.g., calcium oxalate, urate), urinary tract infection,
anatomic anomalies and neoplasia. At a minimum, all cats with signs of lower urinary tract disease should have a urinalysis and
diagnostic imaging performed. Selection of the initial diagnostic imaging procedure (i.e., plain abdominal radiographs or abdom-
inal ultrasonography) may depend on equipment availability; however, using both modalities can be helpful. For radiographs, it
is critical to include the entire urinary tract; otherwise, abnormalities such as urethral uroliths may be overlooked. On the basis
of initial findings, additional tests such as urine culture and contrast urethrocystography may be indicated for some patients. FIC
is diagnosed by excluding all other causes of lower urinary tract disease; therefore, thorough diagnostic evaluation is necessary.
3. A multimodal approach including nutritional management, environmental enrichment, pain management and in some cases,
behavioral modification, is recommended to control clinical signs in patients with FIC. Many treatments have been suggested
for managing affected cats; however, only a few have been evaluated in clinical studies. To date, the treatments that have been
associated with improvement in patients with FIC are feeding moist food and implementing environmental enrichment. Gradual
transition to moist food should be part of initial management. It is believed that increased urine volume associated with increased
water intake results in dilution of inflammatory mediators in the urinary bladder of patients with FIC; however, other effects of
feeding moist food (e.g., increased interaction with owners) cannot be excluded.
Although being overweight or physically inactive has not been shown to cause urinary tract disease, both are risk factors for
FIC. Recent research findings have confirmed that obesity is characterized by a state of systemic inflammation and other nega-
tive consequences such as insulin resistance. Therefore, to improve this cat’s overall health, a weight-reduction program should
be recommended with a goal of reaching ideal body weight and condition.This should include nutritional management and envi-
ronmental enrichment (e.g., increased exercise and interaction with the owner).

Progress Notes
The owner was given additional information about environmental enrichment to help manage clinical signs of FIC and assist with
a
achieving ideal body condition. A moist veterinary therapeutic food was initially recommended until the cat achieved ideal body
weight (4.5 kg). The resting energy requirement (RER) for ideal body weight was calculated as follows: RER = 70(4.5) 0.75 = 218
kcal. In order to lose weight, it was initially recommended to feed approximately 175 kcal per day. The owners were instructed to
transition the food change over seven days by feeding 0.75 can of the therapeutic food (87 kcal) twice daily and monitoring food
intake closely until optimal weight was achieved. Body weight was measured every two weeks and recorded on a progress chart; the
b
cat achieved ideal body weight five months later and was transitioned to another moist therapeutic food formulated for manage-